北京生物医学工程

狭窄几何参数评估稳定型冠心病心肌灌注效能的指导价值

Guiding value of stenosis geometrical parameters in evaluating myocardial perfusion efficacy in stable coronary heart disease

作者：白兰李娜冯懿俐席晓璐孙昊许可乔爱科杨海胜刘健刘有军

单位：北京工业大学环境与生命学部生命科学与化学学院（北京100124） ，北京大学人民医院（北京100044） 通信作者：刘有军。E-mail: lyjlma@bjut.edu.cn

关键词：冠状动脉狭窄；病变累及长度；病变严重程度；心肌灌注；效能评估

分类号：R318.04

出版年·卷·期（页码）：2021·40·4（360-366）

摘要：

目的探讨狭窄病变严重程度和病变累及长度等狭窄形态特征对稳定型冠心病心肌灌注效能的评估价值，提出一项定性定量描述冠心病局域心肌灌注效能的预测指标。方法将54例稳定型冠心病患者纳入统计研究，对其行冠状动脉造影及FFR检查测量，对反映心肌灌注效能的狭窄病变严重程度和病变累及长度等狭窄形态几何参数进行量化分析，包括α值(反映病变严重程度，α=D min/D normal)，β值(反映病变累及长度)，α×β值(反映局部心肌血流供需关系)。结果纳入分析的54组病变数据中，未发生心肌灌注不良者(FFR ≥0.8)43例，心肌灌注不良者(FFR <0.8)11例，心肌灌注不良组α值，β值与未发生心肌灌注不良组间无显著相关性(P >0.05)，但心肌灌注不良组的α×β明显大于未发生心肌灌注不良组(P <0.05)。ROC曲线分析显示，通过α×β值评估病变对于心肌灌注影响的曲线下面积为0.783 (95% CI:0.603~0.964)，敏感度为63.6%，特异度为93.0%，阳性预测值为70.0%，阴性预测值为90.9%，评估准确度为92.6%。结论 α×β值较大组别对应的临床FFR值更小，该项指标与心肌灌注效能之间具有较强敏感性，这与临床现象一致。提示α×β这一指标可定性定量描述冠心病心肌灌注效能，为辅助评价狭窄支血管是否发生局域心肌灌注不足提供理论支持。

Objective

Objective To explore the value of the stenosis morphological characteristics. We would propose a predictor to evaluate the efficacy of myocardial perfusion in stable coronary heart disease. The severity of stenosis lesion and the length of lesion involvement are included. It can qualitatively and quantitatively evaluate efficacy of regional myocardial perfusion in coronary heart disease. Methods 54 patients with stable coronary artery disease are included in research. They were measured by coronary angiography and FFR. The stenosis geometrical parameters including α (reflecting lesion severity, α=D min/D normal), β (reflecting lesion involvement length) and α×β (reflecting local supply and demand relationship of myocardial blood flow) were quantitatively analyzed. Results Among the 54 groups, 43 patients with no myocardial ischemia (FFR ≥0.8) and 11 patients with poor myocardial perfusion (FFR <0.8). There was no significant correlation between the FFR ≥0.8 group and FFR <0.8, but the α×β of FFR <0.8 group was significantly higher than that the FFR ≥0.8 group (P <0.05). And the area under the ROC curve for evaluating myocardial perfusion by α×β value was 0.783 (95%CI: 0.603-0.964), the sensitivity, specificity, positive predictive value, negative predictive value and evaluation accuracy were respectively 63.6%, 93.0%, 70.0%, 90.9% and 92.6%. Conclusions Patients with higher α×β value had lower FFR There was a strong sensitivity between this index and myocardial perfusion efficacy. It was consistent with the clinical phenomenon.

The α×β index can qualitatively and quantitatively describe the efficacy of myocardial perfusion in coronary heart disease, it can provide a theoretical support for the auxiliary evaluation whether myocardial insufficiency occurs.

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